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Answer the questions below, add your name and email address and your results will be sent to you.
How would you rate how busy your life is?
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Not busy at all (5)
Somewhat busy (10)
Usually hectic (15)
Crazily busy (20)
How 'stressed out' are you?
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Never stressed (5)
Mildly stressed (10)
Stressed (15)
Really stressed out (20)
How often are you on the computer in a given day?
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Never (5)
Less than one hour (10)
One to two hours (15)
More than two hours (20)
Do you have digestive problems, such as gas, IBS, reflux, bloating, loose bowels, or constipation?
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No (5)
Yes (25)
Do you suffer from frequent headaches or migraines?
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No (5)
Yes (15)
Please rate your energy levels:
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Great energy all day (5)
Overall ok energy (10)
Some trouble with fatigue (15)
Chronic fatigue (20)
Please rate your eating habits:
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I eat a whole-foods diet all the time (5)
I eat mostly whole foods (10)
I tend to eat processed foods and/or fast food (15)
I only eat processed foods and/or fast food (25)
How would you rate your fruit and vegetable consumption?
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I eat ten to fifteen portions a day (5)
I eat about five to ten portions a day (10)
I hardly eat fruit and vegetables (20)
Your NameDo you exercise?
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Yes (5)
Sometimes (15)
No (25)
How is your weight?
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Normal for my height (5)
Have trouble maintaining weight (10)
5-10 pounds overweight (10)
10-30 pounds overweight (15)
More than 30 pounds overweight (25)
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Name
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First
Last
Email
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Would you be interested in a Healthy Futures Consultation?
*
Yes
No
Phone Number (If you answered yes to the above question)
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Would you like to receive our monthly newsletter?
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Yes
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Please note: This quiz is not meant as a diagnostic tool for any medical condition. It is intended only to get an overall feeling of your health and lifestyle. Always seek medical advice for any physical or psychological problem that you may have.
